(seh-fuh-LEX-in)
Biocef, Keflex, Keftab,  APO-Cephalex, Novolexin, Nu-Cephalex
Class: Antibiotic/cephalosporin

 Action Inhibits mucopeptide synthesis in bacterial cell wall.

 Indications Treatment of infections of respiratory tract, urinary tract, skin and skin structures and bone; treatment of otitis media due to susceptible strains of specific microorganisms.

 Contraindications Hypersensitivity to cephalosporins.

 Route/Dosage

ADULTS: PO 1–4 g/day in divided doses (maximum 4 g/day). CHILDREN: PO (cephalexin monohydrate only) 25–100 mg/kg/day in divided doses.

 Interactions

Probenecid: Inhibition of renal excretion of cephalexin.

 Lab Test Interferences May cause false-positive urine glucose test results with Benedict’s solution, Fehling’s solution, or Clinitest tablets but not with enzyme-based tests (eg, Clinistix, Tes-tape); false-positive test results for proteinuria with acid and denaturization-precipitation tests; false-positive direct Coombs’ test results in certain patients (eg, those with azotemia); false elevations in urinary 17-ketosteroid values.

 Adverse Reactions

GI: Nausea; vomiting; diarrhea; anorexia; abdominal pain or cramps; flatulence; colitis, including pseudomembranous colitis. GU: Pyuria; renal dysfunction; dysuria; reversible interstitial nephritis; hematuria; toxic nephropathy. HEMA: Eosinophilia; neutropenia; lymphocytosis; leukocytosis; thrombocytopenia; decreased platelet function; anemia; aplastic anemia; hemorrhage. HEPA: Hepatic dysfunction; abnormal liver function test results. OTHER: Hypersensitivity, including Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis; candidal overgrowth; serum sickness—like reactions (eg, skin rash, polyarthritis, arthralgia, fever).

 Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Children: Safety and efficacy of cephalexin HCl monohydrate (Keftab) in children not established. Cephalosporins may accumulate in neonates. Hypersensitivity: Reactions range from mild to life-threatening. Administer drug with caution to penicillin-sensitive patients due to possible cross-reactivity. Pseudomembranous colitis: Should be considered in patients in whom diarrhea develops. Renal impairment: Use drug with caution in patients with renal impairment. Dosage adjustment based on renal function may be required. Superinfection: May result in bacterial or fungal overgrowth of non-susceptible microorganisms.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer with food or milk if GI upset occurs. Food slows but does not decrease absorption.
  • Shake oral suspension well before administering. Space doses evenly around clock.
  • Oral suspension is stable up to 14 days after reconstitution when refrigerated.
  • Store capsules and tablets at room temperature.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note renal impairment and allergy to cephalosporins or penicillins.
  • Obtain specimens for culture and sensitivity before beginning therapy and periodically during treatment.
  • Monitor renal function carefully during treatment.
  • Monitor for signs of infection, especially fever, and positive response to antibiotic therapy.
  • Assess for signs and symptoms of anaphylaxis (shortness of breath, wheezing, laryngeal spasm). Have resuscitation equipment available.
  • Assess for signs of superinfection, such as vaginitis or stomatitis.
  • Assess for diarrhea with blood or pus, which may be symptom of pseudomembranous colitis. Symptoms may occur after antibiotic treatment.
OVERDOSAGE: SIGNS & SYMPTOMS
  Seizures

 Patient/Family Education

  • Instruct patient to complete full course of therapy.
  • Advise patient to take with food or milk if GI distress occurs.
  • Remind patient to check body temperature daily. If fever persists for more than a few days or if high fever (> 102°F) or shaking chills are noted, physician should be notified immediately.
  • Advise patient to maintain normal fluid intake while using this medication.
  • Advise diabetic patient to use enzyme-based tests (eg, Clinistix, Testape) for monitoring urine glucose because drug may give false results with other tests.
  • Instruct patient to report these symptoms to physician: nausea, vomiting, diarrhea, skin rash, hives, muscle or joint pain.
  • Instruct patient to report signs of superinfection: black “furry” tongue, white patches in mouth, foul-smelling stools, vaginal itching or discharge.
  • Warn patient that diarrhea that contains blood or pus may be a sign of serious disorders. Tell patient to seek medical care and not to treat at home.
  • Instruct patient to seek emergency care immediately if wheezing or difficulty breathing occurs.

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